Effectiveness of Sexual Health Promotion in Adolescents
Submitted by Larissa McLaughlin, BSN
Eleanor Broer, BSN
The authors illustrate the importance of sexual health promotion in the adolescent population through school-wide and community based efforts through a literature review composed of peer-reviewed, primary sources. The literature reveals that health promotion interventions have proven a reduction in sexual activity and or safer sexual practices, however also reveals a lack of current and numerous studies within the scope of sexual health promotion for adolescents.
A recent study with high school students conducted by the Centers for Disease Control and Prevention (CDC) regarding sexual behavior in adolescents indicated that 47.4% engaged in sexual activity. Out of these adolescents, 39.8% did not use a condom. Every year out of 19,000,000 newly reported sexually transmitted diseases, half are among young people ages 15-24 and an estimated 8,300 adolescents reported testing positive for HIV. Birth rates have dropped by 8% since 2010 among this population subset that has been an all time low for the United States. This may be due to use of oral contraceptives and other non-condom contraceptives (CDC, 2012). It was reported that in 2008, teen pregnancy and labor accounted for nearly $11 billion annually in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational accomplishment and income from teen mothers (CDC, 2011). Only about 50% of teen mothers will receive a high school diploma by the age of 22, compared to approximately 90% of women who had not given birth during their adolescence (CDC, 2011).
These startling facts have led the authors to determine that there has been some recent success shown with health promotion of sexual health and behavior in adolescents. However, the incidence of sexually transmitted diseases is still increasing and teen pregnancy still has detrimental consequences that require further nursing interventions with the adolescents and young adult.
The literature reveals that health promotion interventions have proven a reduction in sexual activity and/or safer sexual practices. It also demonstrates the need for a more consistent intervention programs to take place for longer periods of time.
Registered nurses employ strategies of health teaching and health promotion in order to promote health in a safe and comforting environment (American Nurses Association, 2010). Nurses are on the front line of health care. They are often the first to interact and build a rapport with patients. Teenagers that engage in risky sexual behavior may seek aid from nurses first. The nurse’s scope of practice includes providing education and a source of comfort and support to patients of all ages. Nurses are also heavily involved in the community as school nurses, guest speakers in health classes, and primary care practitioners. Creating an environment of respect from the patient where they choose to disclose information to nurses that they would normally not share to family or doctors is key to education and increasing the likelihood of patient compliance. A patient may also seek information or advice from a knowledgeable nurse, so it is imperative for the nurse to be able to provide age appropriate information regarding sexual health.
This literature review may help to shape how practitioners and nurses tailor their education as well as offer effective strategies on how to address this young population. Reducing sexually transmitted diseases and unplanned teen pregnancies will reduce societal health care related costs in addition to other costs related to unemployment and social services.
This information may have a greater reach beyond nurses and serve as a resource to non-medical personnel who work with adolescents. For example, health instructors in schools, parents of adolescents, community center leaders, adolescents themselves, and even the general public may take interest in the information provided.
The Journal of Adolescent Health published an article in 2012 titled “Reducing Sexual Risk Behavior in Adoldescent Girls: Results from a Randomized Controlled Trial” (Morrison-Beedy, Jones, Xia, Tu, Crean, & Carey, 2013). Adolescents are at high risk of developing sexually transmitted infections (STIs), the human immunodeficiency virus (HIV), and unplanned pregnancies due to risky sexual behaviors. Among this population, teenage girls aged 15-19 have the highest rate of HIV and STIs compared to those of boys their same age. Over 50% of this group are African-American girls residing in low-income areas. Morrison-Beedy et al evaluated the efficacy of sexual risk reduction (SSR) interventions using the Information-Motivation-Behavioral (IMB) skills model among a sampling of low-income, urban, sexually active adolescent girls. This intervention hypothesized that there would be a reduction in total vaginal sex exposures, unprotected vaginal sex and number of partners amongst girls enrolled in the SSR intervention compared to those in the control group (Morrison-Beedy, Jones, Xia, Tu, Crean, & Carey, 2013).
English speaking girls aged 15-19 years old were recruited to participate in Morrison-Beedy et al’s study. The criteria included: unmarried, not pregnant, have not given birth within the past three months, and who were sexually active the past three months. Participants were predominantly African-American and from low-income communities. Two groups were formed randomly, one being the control group and one being the SSR intervention group. Both interventions consisted of four, weekly 120 minute sessions and two 90 minutes booster sessions at 3 and 6 months. The SSR interventions provided HIV information, readiness to reduce risk behaviors, instructed and modeled condom use, addressed concerns of how to persuade a partner to use a condom, how to obtain condoms and how fertility could be jeopardized by risky sexual behavior. Results yielded that participants in the SSR intervention group had fewer episodes of vaginal sex, had fewer incidents of unprotected sex, were more likely to be sexually abstinent and had a 50% reduction in positive pregnancy tests (Morrison-Beedy et al., 2013). At follow up booster meetings at both 3 months and 6 months the effects of SSR intervention was still positive. It was found however that at 12 months there was a larger increase in vaginal sexual episodes due to no booster sessions taking place in 6 months.
This study and the results of the researchers Morrison-Beedy et al further illustrate the need of continuous health promotion and interventions among this population and age group. It also addresses the research question of the effectiveness of sexual health promotion amongst this population, because clearly some promotion and education is effective but it is not being maximized to its full potential.
In the article, “The “Safer Choices” Intervention: Its Impact on the Sexual Behaviors of Different Subgroups of High School Students” it examined the impact of the Safer Choices program. Safer Choices is a 2-year school based HIV/STD and pregnancy prevention program aimed at high school students. The program included five primary components: School Organization, Curriculum and Staff Development, Peer Resources and School Environment, Parent Education and School-Community linkages. School Organization included teachers, parents, students, community members and administrators that formed a School Health Promotion Council. The Curriculum and Staff Development included lessons to 9th and 10th graders that included interactive activities related to STI, HIV, and pregnancy education. Peer group leaders also participated by spearheading selected curriculum activities. Peer Resources and School Environment saturated the school environment with information, services, and activities that reinforced the health promotion messages instructed in the classroom. Student peers published articles in the school newspaper, conducted polls, organized assemblies and guest speakers and organized small-group discussions. Parent Education was to serve as a way to increase communication between the parent and the child. Newsletters were sent home to parents about what was being communicated to their children. The student/child was encouraged to include their parents in homework assignments that focused on sexual health. The final group School-Community Linkages served to educate students on community based resources pertaining to HIV, STD, and pregnancy prevention.
This program included 20 high schools; 10 schools in Texas and 10 schools in Northern California. The program included a multi-dimensional approach being a theory-driven multi-component and curriculum based intervention. Results yielded that the long-term impact (31 months) had positive effects on both genders and all major ethnic groups. It was especially effective with the Hispanic population and higher-risk youth who had already engaged in unprotected sex at an early age. In addition it was highly effective at implementing greater condom use with the male population. This study concluded that programs such as Safer Choices are highly effective at reducing high-risk sexual behaviors amongst all groups of teenagers (Kirby, Baumler, Coyle, Basen-Engquist, Parcel, Harrist, Banspach, 2004).
In the article, “Understanding the Impact of Effective Teenage Pregnancy Prevention Programs”, the review evaluated five adolescent pregnancy prevention programs from across the nation. The programs included were: Postponing Sexual Involvement (Atlanta, Georgia), Reducing the Risk (California), School/Community Program (South Carolina), Self Center (Baltimore, Maryland), and Teen Talk. The programs reviewed demonstrated that they reduced the rate of teenage sexual initiation by 15%. For older adolescents that have already initiated sexual intercourse the programs demonstrated a broader use of contraceptives. The review concluded that widespread implementation of similar programs may increase the percentage of sexually active adolescents who use contraceptives by as much as 22 percentage points. Programs would not eliminate teen pregnancy in the United States but would increase safer sexual practices and reduce the incidence of teenage pregnancies (Frost & Forrest, 1995). Frost and Forrest further concluded the need for “continued program development and evaluation in a number of areas” stressing that only a subset of the population was evaluated and the need for a wider based population (Frost & Forrest, 1995, p. 195).
Based on the review of literature it appears that implementation of widespread, multi-dimensional programs that target both at risk sexually active adolescents and adolescents that have not yet engaged in sexual activity are the most effective. Interventions such as the “Safer Choices” program not only incorporate students and teachers, but community members, parents, and school administrators. This multi-dimensional approach contributes to a more effective health promotion model aimed at adolescents.
Focus groups and interventions that are curriculum and program based in the schools also yield robust results in the adolescent population. Programs that last throughout the tenure of each student/adolescent would further increase the likelihood that a student would be abstinent or more often practice safe sexual behaviors.
During this literature review the authors concluded that there was an insufficient amount of current research studies on the effectiveness of sexual health promotion in adolescents. Further examination of this topic would provide a more conclusive correlation.
While the current statistics regarding adolescent pregnancy and STIs are shocking and discouraging, it is important to remember that there has been an improvement since prior years. The literature reviewed does make a positive correlation between health promotion interventions and a reduction in sexual activity and safer sexual practices in adolescents. The analysis demonstrated that there is a lack of research on this topic and identified the need for a more widespread, consistent intervention program to take place for a greater length of time. This literature review focused on inner-city populations, and it is necessary to continue these education programs not only within the urban areas but expand them on a much larger scale. The authors hope that nurses and education professionals in all arenas understand their important role to aid in decreasing the startling statistics as well as educating patients as much as possible with methods learned from this study, such as the multi-dimensional approach with a variety of approaches used while maintaining consistency and regularity. It is vital for a community to collaborate in regards to adolescent sexual health promotion in order for changes to be made.
American Nurses Association. (2010). Scope and standards of practice: Nursing
(2nd ed.). Silver Spring, MD: nursesbooksorg
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Frost, J., & Forrest, J. (1995). Understanding the impact of effective teenage pregnancy prevention programs. Family Planning Perspectives, 5, 188-195.
Kirby, D., Baumler, E., Coyle, K., Basen-Engquist, K., Parcel, G.,
Harrist, R., Banspach, S. (2004). The “safer choices”
intervention: Its impact on the sexual behaviors of different subgroups of high school students. Journal of Adolescent Health, 35, 442-452.
Morrison-Beedy, D., Jones, S., Xia, Y.,Tu,X., Crean, H., & Carey, M. (2013). Reducing
sexual risk behavior in adolescent girls: Results from a randomized controlled
trial. Journal of Adolescent Health, 52, 314-321.